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Cheatography

Common HA/less serious causes

Cervic­ogenic HA

Clinical Findings
Reduced Neck ROM
Reproduced by moving the neck/p­ressure over C2 NR
Ipsila­teral Should­er/Arm Pain
Unilat­eral, Doesn't change sides
C1-C3 NR affected
Can present with Nausea, Vomiting, photo/­pho­nop­hobia
TrP in Upper Traps, Lev Scap, Scales + Subocc­ipital Extensors
Weak Deep Neck Flexors

Classf­ica­tions

A. Pain referred from a source in the neck & perceived in >1 regions of the head/face + C+D
B. Clinic­al,­lab­/im­aging evident of a disord­er/­llesion within the cx or soft tissues of the neck known to be,or generally accepted as, a valid cause of HA (no cx spondy­losis)
C. Evidence of HA caused by neck dysfun­ction - criteria at least one of the following:
1. clinical signs that point to a pain in the neck
2. abolition of HA - diagnostic blockade of cx structure
D. Pain resolves within 3 months of treatment

Management

Physical Therapy:
Cx Spine Mobili­sat­ion­/Ma­nip­ulation
Upper Quarte­t/DNF streng­thening
Tx Spine Manipu­lations + Exercise
Postural Training
 
 
Medi­cat­ions:
Antide­pre­ssants
Muscle relaxants
Botox
Steroid Inject­ion­s/Nerve blocks

Hypnic HA

S&S
Headache that wakes patient up at night
Can be unilat­era­l/b­ila­teral
Begins abruptly
Can have autonomic features
Dull-m­oderate severity
Responds well to lithium + caffeine

Mana­gem­ent

Exclude 2ndary HA - drug withdr­awal, sleep apnoea, brain tumours, TA
Exclude primary HA - migraines, cluster HA, chronic paroxysmal hemicrania
Refer to GP - specialist
Lithiu­m/c­affeine most effective
 

Tension Type Headaches

S&S
Bilateral, Pressi­ng/­tig­htening
Mild-M­oderate Intensity
Can present with migraine symptoms (nausea, vomiting, photo/­pho­nop­hobia
Usually lasts minutes to days
NOT WORSENED WITH PHYSICAL ACTIVITY

Mana­gem­ent

Cx Exercises
Relaxation
Massage
Postural Exercises
Cranio-cx technique
1000mg parace­tamol + 130mg caffeine

Migraine

S&S
Unilat­eral, severe pulsat­ing­/po­unding HA
Radiates to perior­bit­al/­ret­roo­rbital
Nausea, photo/­pho­nop­hobia, lack of appeti­te,­moo­d/l­ibido
Triggered by certain things (food, smells, stress­,de­hyd­ration)
Can be with aura/w­ithout
Scinti­llating scotoma (flash­y,z­igziggy lights - obstruct visual field)
Can present with hemiplegia

Management

Drugs: Aspirin (900mg), ibupro­fen­(40­0-8­00mg), parace­tamol (1g)
Lifestyle Changes - identi­fying Triggers
Massage
Stress relief
Cold pack @ back of neck
 

Cluster HA (Rare) - TAC

S&S
Excruc­iating unilateral perior­bit­al/­tem­poral pain
Sharp, pulsating, pressure like pain - usually on the right side
ipsila­teral autonomic symptoms: Conjun­ctival injection & lacrim­ation, nasal conges­tio­n/r­hin­orhea, forehe­ad/­facial sweating, facial flushing, eyelid oedema, miosis­,ptosis
Restle­ssness & agitation
Can present with Auras,­pho­to/­pho­nop­hobia, nausea + vomiting
Pain in 1st trigeminal branch - always on same side of head
Physical activity relieves pain

Mana­gem­ent

Avoid Triggers
GP Referal
Triptans, steroids, oxygen inhalation

Occipital Neuralgia

S&S
Pierci­ng/­thr­obbing in upper neck, back of the head, behind ears
Unilateral
Scalp tender to touch
Photop­hobia

Causes

Pinching of the nerves (greater + lesser)
Tight muscles - microt­rauma
Too much extension for long periods
OA
Tumour in neck
infection
Gout
Diabetes
Vasculitis

Mana­gem­ent

Massage
Rest
Antide­pre­ssant
Nerve block
Steroids
Treating underlying cause
 

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